2019 HSC Section 2 - Practice Management

Reprinted by permission of J Gen Intern Med. 2016; 31(1):45-51.

Patient Use of Email, Facebook, and Physician Websites to Communicate with Physicians: A National Online Survey of Retail Pharmacy Users Joy L. Lee, PhD, MS, MS 1,2 , Niteesh K. Choudhry, MD, PhD 1 , Albert W. Wu, MD, MPH 2 , Olga S. Matlin, PhD 3 , Troyen A. Brennan, MD, JD 3 , and William H. Shrank, MD, MSHS 1,3 1 Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women ’ s Hospital and Harvard Medical School, Boston, MA, USA; 2 Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA ; 3 CVS Health, Woonsocket, RI, USA.

BACKGROUND: Patient – physician communication often occurs outside the clinic setting; many institutions dis- courage electronic communication outside of established electronic health record systems. Little empirical data are available on patient interest in electronic communication and Web-based health tools that are technically feasible but not widely available. RESEARCH OBJECTIVE: To explore patient behavior and interest in using the Internet to contact physicians. DESIGN: National cross-sectional online survey. PARTICIPANTS: A sample of 4,510 CVS customers with at least one chronic condition in the household was used to target patients with chronic conditions and their care- givers. Subjects were identified from a national panel of over 100,000 retail pharmacy customers. Of those sam- pled, 2,252 responded (50.0 % response rate). MAIN MEASURES: Survey measures included demo- graphic and health information, patient use of email and Facebook to contact physicians, and patient interest in and use of Web-based tools for health. KEY RESULTS: A total of 37 % of patients reported contacting their physicians via email within the last six months, and 18 % via Facebook. Older age was negatively associated with contacting physicians using email (OR 0.57 [95 % CI 0.41 – 0.78]) or Facebook (OR 0.28 [0.17 – 0.45]). Non-white race (OR 1.61 [1.18 – 2.18] and OR 1.82 [1.24 – 2.67]) and caregiver status (OR 1.58 [1.27 – 1.96] and OR 1.71 [1.31 – 2.23]) were positively associated with using email and Facebook, respectively. Patients were interested in using Web-based tools to fill prescriptions, track their own health, and access health information (37 – 57 %), but few were currently doing so (4 – 8 %). CONCLUSIONS: In this population of retail pharmacy users, there is strong interest among patients in the use of email and Facebook to communicate with their physi- cians. The findings highlight the gap between patient in- terest for online communication and what physicians may currently provide. Improving and accelerating the adoption of secure Web messaging systems is a possible solution that addresses both institutional concerns and patient demand.

KEY WORDS: communication; health information technology; patient preferences. J Gen Intern Med 31(1):45 – 51 DOI: 10.1007/s11606-015-3374-7 © Society of General Internal Medicine 2015

BACKGROUND Patient – physician communication is a critical domain of the quality of care, 1 , 2 and poor patient – physician communication is associated with poor patient health outcomes and low pa- tient satisfaction. 3 , 4 Technological advances over the past few decades have opened more avenues through which patients and physicians can communicate with one another; among them, email and social media are potential channels to enhance communication. Yet the efficiency presented by email and social media sites like Facebook.com (hereafter referred to as Facebook) may not be enough to convince physicians to use them to commu- nicate with patients. It is important, therefore, to understand patient interest in and expectations of the use of email and Facebook to communicate with their physicians, and how this may compare with policies guiding physician communication as well as what physicians themselves want and expect. Institutional policies generally restrict physician use of email and social media for patient communication in view of privacy and liability concerns. For example, the American College of Physicians (ACP) states that B e-communication between pa- tients and physicians [ … ] requires discussion and previous agreement before electronic exchange is initiated. ^ 5 Although an estimated 20 % of physicians communicate with their patients by email, anecdotal evidence suggests that many do not engage their patients in discussion about e-communication prior to its occurrence. 6 Patients also appear more interested than their physicians in using online communication for clin- ical purposes, 7 – 9 perhaps because they face fewer barriers to entry than physicians, who must juggle concerns of institu- tional guidelines, liability, and the intrusion on their time. 7 – 9 According to the Pew Research Center, close to 90 % of U.S. adults use the Internet, and among these, 72 % visit social media websites like Facebook. 10 , 11 Beyond socializing, users

Received June 5, 2014 Revised November 11, 2014 Accepted April 16, 2014 Published online June 24, 2015

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